Pew Urges ONC to Expand USCDI to Boost Patient Data Exchange

The Office of the National Coordinator for Health Information Technology (ONC) should expand the data required in the United States Core Data for Interoperability (USCDI) to improve public health efforts and patient data exchange, according to Pew Charitable Trusts.

ONC defined USCDI as “a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.”

The agency adopted the first version of USCDI as a standard in the ONC Final Rule. It set a foundation for increased patient data sharing to boost patient care

In January 2021, ONC released USCDI Version 2 to enhance interoperability and patient data exchange between patients, providers, and other users.

“We recognize that these criteria may change each year based on trends within the submissions received, high priority target areas, and other factors,” wrote ONC in January. “We aim to provide relevant details on a given year’s priorities in order to provide greater transparency into the process and ensure continued alignment of USCDI submissions to high priority target areas for health IT and health care.”

However, Kathy Talkington, director of Health Programs at Pew, said USCDI Version 2 is missing valuable information to help combat public health crises, such as COVID-19.

“When finalizing the proposed version, ONC should ensure the USCDI includes data needed for public health and health equity, which can help public health agencies fight the current pandemic—and be better prepared for future crises,” Talkington wrote in a letter to ONC.

According to Pew, over 40 percent of lab results are missing important patient data.

To strengthen USCDI, Pew recommended ONC:

• Require the use of US Postal Service (USPS) standard to boost patient matching
• Include key data elements, such as travel history, employment, and death date
• Accelerate social determinants of health (SDOH) data integration

“Given these existing gaps, ONC should ensure the USCDI includes data needed for public health and health equity, which can help public health agencies fight the current pandemic—and be better prepared for future crises,” Talkington added.

Standardizing data elements, such as phone numbers and addresses, is crucial to patient matching. Talkington said patient matching could improve with the help of USPS formatting. USPS address formatting can increase matching by up to 3 percent, according to a 2019 study published in the Journal of the American Medical Informatics Association.

“Using additional data elements to verify individuals’ identities can help do that,” Talkington explained.  

“ONC rightly added more demographic data to the USCDI in version 1, including current and previous addresses; phone number (as well as the type of number, such as a cellphone or home landline); and email address,” she continued.

Pew recommended ONC integrate additional demographic data, such as health plan ID or Medicare Beneficiary ID to provide a standardized way to improve patient matching and link patient records across systems.

However, ONC said integrating this standard would result in provider burden.

“Instead, ONC created Project US@, a multi-stakeholder initiative to create a health care-specific format for address, building off of and removing existing variation in the USPS standard,” Talkington said. “However, this process will take time to develop a more specific standard, and ONC should not delay adoption of the USPS standard in the interim. Even with the variation allowed in the USPS standard, adoption would lead to fewer discrepancies and differences in address depiction than exists today.”

Next, Pew suggested ONC integrate specific public health data elements to boost patient data exchange during a public health situation, such as COVID-19.

Pew said ONC should include an existing “problems” data class, a “specimen” data class, a “travel history” data class, a “work information” data class, an “observations” data class, and also include a “death date” data class.

“Including data needed for public health as part of the USCDI will ensure that all EHRs are able to document and exchange this information in a standard manner, including with public health agencies,” wrote Talkington.

Research shows that identifying and implementing individual SDOH data into the EHR is crucial to finding answers to significant health issues. Studies show this data accounts for 80 to 90 percent of individuals’ health.

Once identified, SDOH data can create opportunities to offer social services and interventions for high-risk individuals.

“The COVID pandemic has also highlighted the importance of using data to improve equity of care, and how missing data can make it harder to target resources, distribute vaccines appropriately, and assess the risks to different communities,” Talkington explained.

“Yet, USCDI fails to include many important SDOH data elements. We encourage ONC to accelerate their inclusion of SDOH in USCDI version 2”

Talkington said providers and patients should engage in conversations about the importance of SDOH data, which could ultimately allow individuals to give providers access to collect and share SDOH data.

“USCDI version 2 is an opportunity to ensure data needed for patient care and public health activities are included within standards for exchange,” concluded Talkington.

“The COVID-19 pandemic has highlighted the existing gaps in current mechanisms for data exchange, both between health care facilities and with public health agencies. A comprehensive USCDI could help close these gaps and ensure complete, standardized data can be seamlessly shared with those who need it.”